Palmas Walter, Ma Shuangge, Psaty Bruce, Goff David C, Darwin Christine, Barr R Graham
Division of General Medicine, Department of Medicine, Mailman School of Public Health, Columbia University Medical Center, New York, New York.
Am J Hypertens. 2007 Mar;20(3):233-41. doi: 10.1016/j.amjhyper.2006.08.006.
The effects of different antihypertensive medication classes on C-reactive protein (CRP) levels are still not well characterized, and might be of relevance to treatment choices.
We studied the association between antihypertensive medication class and CRP levels among participants with treated hypertension in the Multi-Ethnic Study of Atherosclerosis. We performed a cross-sectional study of hypertensive participants free of clinical cardiovascular disease who were taking one or more of the following medication classes: beta-blockers, calcium channel blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II type I receptor blockers (ARB).
Among 2340 participants taking one or more antihypertensive medications, the mean serum CRP level was lower among participants taking a beta-blocker than among those not taking a beta-blocker (2.13 v 2.54 mg/L, P = .002). This difference persisted after multivariate adjustment (P = .021). There were no other statistically significant differences in multivariate models. Among 1314 participants receiving monotherapy, the multivariate adjusted mean CRP level among participants taking a beta-blocker was lower (1.97 mg/L) than those taking a diuretic (2.72 mg/L, P < .001). In this monotherapy group, participants taking an ACE inhibitor or ARB also had a lower adjusted mean CRP (2.25 mg/L) than those taking a diuretic (P = .046). African-American race/ethnicity did not modify any of those relationships.
The beta-blocker use was associated with lower CRP levels overall and among participants on monotherapy, whereas ACE inhibitor and ARB use was associated with lower CRP levels among participants on monotherapy. These findings warrant further evaluation in randomized trials.
不同类别降压药物对C反应蛋白（CRP）水平的影响仍未得到充分阐明，这可能与治疗选择相关。
在动脉粥样硬化多民族研究中，我们研究了接受治疗的高血压参与者中降压药物类别与CRP水平之间的关联。我们对无临床心血管疾病的高血压参与者进行了横断面研究，这些参与者正在服用以下一种或多种药物类别：β受体阻滞剂、钙通道阻滞剂、利尿剂、血管紧张素转换酶（ACE）抑制剂或血管紧张素II 1型受体阻滞剂（ARB）。
在2340名服用一种或多种降压药物的参与者中，服用β受体阻滞剂的参与者的平均血清CRP水平低于未服用β受体阻滞剂的参与者（2.13对2.54 mg/L，P = .002）。经过多变量调整后，这种差异仍然存在（P = .021）。多变量模型中没有其他具有统计学意义的差异。在1314名接受单一疗法的参与者中，服用β受体阻滞剂的参与者经多变量调整后的平均CRP水平（1.97 mg/L）低于服用利尿剂的参与者（2.72 mg/L，P < .001）。在这个单一疗法组中，服用ACE抑制剂或ARB的参与者经调整后的平均CRP水平（2.25 mg/L）也低于服用利尿剂的参与者（P = .046）。非裔美国人种族/族裔并未改变这些关系中的任何一种。
总体而言，使用β受体阻滞剂与较低的CRP水平相关，在单一疗法的参与者中也是如此，而使用ACE抑制剂和ARB与单一疗法参与者中较低的CRP水平相关。这些发现值得在随机试验中进一步评估。
